title: Association between Technical Performance Scores and neurodevelopmental outcomes after congenital cardiac surgery.
abstract: OBJECTIVE
  Technical Performance Score (TPS) has been shown to have a strong association with early and late outcomes after congenital cardiac surgery, with greater morbidity and reintervention in children with major residual lesions (TPS class 3). We sought to explore the effect of TPS on the neurodevelopmental outcomes.
  
  
  METHODS
  All infants undergoing cardiac surgery, excluding those with trisomy 21, were offered neurodevelopmental testing at 1 year of age using the Bayley Scales of Infant Development, 3rd edition. TPSs from the discharge echocardiograms were graded as class 1 (optimal), class 2 (minor residual), or class 3 (major residual). Multivariate regression analysis was performed using patient characteristics and preoperative variables.
  
  
  RESULTS
  Neurodevelopmental testing was performed in 140 patients at a median age of 16 months. Of these, 28 (20%) had single ventricle palliation; 39 (28%) were in Risk Adjustment for Congenital Heart Surgery category 4 to 6. Significant differences between the groups were found in the cognitive (P = .01) and motor (P = .05) domains, with subjects in TPS class 3 having significantly lower cognitive and motor composite scores. The scores did not vary significantly according to single ventricle versus biventricular repair or Risk Adjustment for Congenital Heart Surgery categorization. In multivariate modeling, class 3 TPS remained significantly associated with a lower Bayley cognitive score (P = .02), with a trend toward a lower Bayley motor score (P = .08).
  
  
  CONCLUSIONS
  We found that TPS is an independent predictor of neurodevelopmental outcomes after infant heart surgery. Future research should explore whether a structured program of intraoperative recognition and intervention on residual lesions can improve the TPS and neurodevelopmental outcomes.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass. Electronic address: meena.nathan@cardio.chboston.org.
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
authors.affiliation: Cardiac Neurodevelopmental Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Anjali
authors.initials: A
authors.lastname: Sadhwani
authors.affiliation: Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.affiliation: Medicine Critical Care Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Michael
authors.initials: M
authors.lastname: Agus
authors.affiliation: Cardiac Neurodevelopmental Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Janice
authors.initials: J
authors.lastname: Ware
authors.affiliation: Cardiac Neurodevelopmental Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Cardiac Neurodevelopmental Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Frank
authors.initials: F
authors.lastname: Pigula
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002657:Child Development; D003071:Cognition; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D009043:Motor Activity; D015999:Multivariate Analysis; D009420:Nervous System / Q000254:growth & development*; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors